Are there any hours you cannot work?* Yes NoPlease select if there are any hours you are unavailable to work.

If yes, explain Invalid Input

Do you require working papers? (under 18 years of age)* Yes NoPlease specify if you require working papers.

Date you are available to start working*

Please enter the date you are available to start working.

Any relatives or friends working for us?* Yes NoPlease specify if you have any relatives or friends working for us.

If yes, give names and locations Invalid Input

Can you perform essential job functions with or without reasonable accommodations? Describe:* Required field.

Will you be able to provide proof of U.S. citizenship or permanent residency upon employment?* Yes NoPlease specify if you are a U.S. Citizen.

Education

High School Name Invalid Input

Address Invalid Input

Grade Completed Invalid Input

Degree/Major Invalid Input

College Name Invalid Input

Address Invalid Input

Grade Completed Invalid Input

Degree/Major Invalid Input

Other Name Invalid Input

Address Invalid Input

Grade Completed Invalid Input

Degree/Major Invalid Input

Other Name Invalid Input

Address Invalid Input

Grade Completed Invalid Input

Degree/Major Invalid Input

Employment History (starting with most recent)

Employed from

Invalid Input

To

Invalid Input

Company Name Invalid Input

Address Invalid Input

Phone Invalid Input Name & Position of Supervisor Invalid Input

Salary Start Invalid Input

Salary End Invalid Input

Your job title and duties Invalid Input

Reason for leaving Invalid Input

Employed from

Invalid Input

To

Invalid Input

Company Name Invalid Input

Address Invalid Input

Phone Invalid Input Name & Position of Supervisor Invalid Input

Salary Start Invalid Input

Salary End Invalid Input

Your job title and dutiesInvalid Input

Reason for leavingInvalid Input

Employed from

Invalid Input

To

Invalid Input

Company Name Invalid Input

Address Invalid Input

Phone Invalid Input Name & Position of Supervisor Invalid Input

Salary Start Invalid Input

Salary End Invalid Input

Your job title and duties Invalid Input

Reason for leaving Invalid Input

If currently employed, may we contact your employer for reference purposes? Yes NoInvalid Input

If yes, give name, position and telephone number of person to be contacted Invalid Input

1. I hereby declare that the information provided by me in this application is true, correct and complete to the best of my knowledge and that any misrepresentation or falsification of this information shall be considered cause for cancellation of this application and/or separation from LIA's service if I have been employed.

2. I authorize LIA to investigate and check any of the foregoing data and references.

3. I agree to conform to the policies and procedures of LIA and I understand that work schedules are subject to change and that overtime may be required.

4. I understand that just as I am free to resign at any time, LIA reserves the right to terminate my employment at any time, for any lawful reason, with or without cause and without prior notice. I understand that no representative of LIA has the authority to make any statement to the contrary.